Frequently Asked Questions

What are Learning Related Visual Problems?

Learning related visual problems are a group of visual skill problems that have certain, predictable associated signs and symptoms. Visual skills include efficient control of the actions/movements of the eyes, perceptual processing of visual information, and visually guided motor abilities. (Depending on the type of categorization used, there are approximately 10 different visual skills). When several visual skills are inadequate, a Learning Related Visual Problem is difficulty achieving up to potential in school. Some hallmark signs are difficult keeping place while reading, eyestrain, poor penmanship and frequent word recognition errors for common words.

Why does my child have poor visual skills? What caused his visual skills to be inadequate? Did he/she inherit this condition?

Learning related visual skill problems are usually not in inherited. They are acquired in one of 3 ways

1. Developmental Lag

Visual skills and abilities are learned during the overall process of child development – just like language (speaking, listening) and motor skills (crawling, walking, running etc) For some children, the visual developmental experiences that took place were insufficient. Therefore, their visual skills lag developmentally behind where they should be for successful school performance. Developmental lag is the most common cause for the deficits in a category of visual skills called Visual Information Processing.

2. Visual Stress

Prolonged use of vision for nearpoint tasks such as reading and writing is stressful to the visual system. Some individuals react to this stress with a deterioration of their visual skills. This visual stress reaction is more common in older children and adults who are engaged in prolonged reading. The visual skills that are usually affected by visual stress are Eye Focusing (Ocular Accommodation) and Eye Teaming (Binocular/Vergence Skills).

3. Disease or Injury to the Brain

This cause of inadequate visual skills is the most obvious but it is also the least common. Head trauma, fetal exposure to alcohol and genetic disorders such as Down’s Syndrome. Are examples of conditions that can affect the brain and visual skills.

There are a few specific diagnoses such as a wandering eye that can be inherited. Inherited Learning Related Vision Problems are uncommon and an exception to the rule.

Is there something physically wrong with my child? Are the eye muscles weak?

No, there is no physical abnormality that can be identified by physical testing such as an x-ray or CT scan. The eye muscles are not weak either. Visual skill problems are based on measurements and observations of performance. They relate to how well you child uses his eyes and brain to gather and process visual information.

What will happen if we do nothing about this problem? Will my child simple grow out of it?

Unfortunately, no. Inadequate visual skills persist over time and if not treated the child is faced with compensating or avoiding visually based tasks. For certain children with a minor visual skill deficiency, “growing out of it” is possible. In this instance, your optometrist may recommend frequent follow-up evaluations and offer home guidance suggestions.

During my child’s evaluation, I observed some tests that looked like tests of body coordination. There was also a test with questions about left and right. What do these tests have to do with the eyes?

Actually, none of the visual skill tests were “eye” tests. Visual skill testing related to how well your child controls the actions and movements of the eyes, and, how well he or she processes the information that is sent to the brain by the eyes. Visual skills are mental processes. There are not “eye” skills.

The reason your optometrist administered tests that resembled body coordination tasks and asked about left right awareness is that vision is used to plan and guide whole body movement as well as small motor tasks. Also, awareness of direction and where things are in space is mediated by visual skills and abilities.

How does Vision Therapy actually work? Do the eyes get stronger?

The eyes and eye muscles do not strengthen with Vision Therapy. Vision Therapy is not physical exercises. Through Vision Therapy, the patient improves existing strategies and gains new ones that allow more efficient control of the eyes and more efficient processing of visual information.

Vision Therapy consists of a series of activities in which the patient actively participates under carefully arranged conditions. The activities are targeted to the visual skill(s) that were previously identified as weak. The level of difficulty of the Vision Therapy activity is carefully selected so that is challenges the patient but is not too hard. The patient practices the activity while receiving guidance and feedback from the therapist until the activity becomes easy and is no longer a challenge. Then, another Vision Therapy activity is assigned that is more difficult than the first one, and so on. As the patient sequentially progresses through a hierarchy of Vision Therapy activities, his/her visual strategies improve and become more efficient. A key ingredient to Vision Therapy programs is the use of lenses and prism. These tools are used to raise or lower the difficulty of a Vision Therapy acitivity. They can also increase awareness of how and individual is using their vision.

After my child completes Vision Therapy, will the visual skill problems come back? Will he need Vision Therapy again?

Regression of visual skills that have improved is uncommon. It is unlikely that you child will need a Vision therapy program more than once. Sometimes maintenance Vision Therapy activities are assigned for home practice following a Vision Therapy program as a way to minimize the possibility of regression. Also, your optometrist will see you child for a follow-up evaluation 3 to 6 months after Vision Therapy.

There are exceptions to the general rule that visual skills do not regress once improved. Intermittent strabismus and amblyopia, for example, often require ongoing Vision Therapy. Please ask your optometrist about your child’s specific case.

What is the success rate of Vision Therapy? Do all of the visual skills reach normal levels after Vision Therapy?

The success rate of Vision Therapy is very high, close to 100%, if the goal is improved visual skills with concurrent improvement in the associated school performance indicators. For example, keeping place while reading is dependent on several visual skills, notably Eye Tracking. As Eye Tracking improves during a Vision Therapy program, patients and their parents notice that is easier to keep place while reading.

The success rate of Vision Therapy for the goal of all deficient skills reaching normal levels is good but not 100%. It is possible for 1 or 2 visual skills to remain below expected after Vision Therapy. For some Vision Therapy patients a plateau occurs where a visual skill improves via Vision Therapy but then levels off. In this instance persistent visual skill deficit remains after Vision Therapy.

Another success rate that may be considered is the success rate of Vision Therapy for eliminating Learning Disabilities. In this instance, it is important to realize that it is not the specific goal of Vision Therapy to eliminate Learning Disability. Rather the goal of Vision Therapy, according to an Organizational Policy Statement from 3 major optometric associations, is “ ..improvement of visual function with the alleviation of associated signs and symptoms”. Also, form the same policy statement “ Vision Therapy does not directly treat learning disabilities or dyslexia”.

Will my child continue to struggle in school after Vision Therapy?

The answer to this question is not straightforward and it depends on the nature of your child’s learning problem. If visual skill problems are the dominant reason your child is struggling and other important learning factors such as language processing and attention are in place, then Vision Therapy will have a significant beneficial impact on the academic performance. On the other hand, if your child has multiple problems that require intervention, then Vision Therapy will not eliminate all of your child’s academic difficulties. School performance is dependent upon many factors – one of which is good visual skills. Therefore, improving school performance often requires a multidisciplinary approach. Optometrists working with children like yours are only one of a number of professionals in the multidisciplinary team that help children overcome learning problems.

Is Vision Therapy for Learning Related Vision Problems new? I’ve never hear of it before?

No, Vision Therapy has been a specialty service with the profession of optometry since the 1920’s. A small percentage of optometrists include Vision therapy in their practices as a specialty.

While it is true that Vision Therapy is not new, its is also true that many people have never heard of it before. The majority of people seeking vision care do not need Vision Therapy and this option is not brought up during routine eye and vision care. Furthermore, many eye doctors and other professionals limit the definition of vision to the optical eye conditions. They are unaware or unconvinced that vision is more than the ability to see 20/20. Vision is a complex proves that includes healthy eyes, clear eyesight (20/20) and spectrum of visual skills that are used to control the actions of the eyes and process visual information.